FAMILY PLANNING (Hansard, 12 December 1972)

§ The Secretary of State for Social Services (Sir Keith Joseph)
With permission, Mr. Speaker, I should like to make a statement about family planning.
My right hon. Friends, the Secretaries of State for Wales and Scotland, and I have carried out a comprehensive review of the provision for family planning services within the National Health Service. We have concluded that a substantial expansion is needed if the numbers of unwanted pregnancies are to be reduced. With modern contraceptive methods available there should be fewer abortions and much less of the unhappiness and ill-health which results from unplanned pregnancies.
There are three areas in which we need to improve our family planning services—advice, education, and free supplies for those who need them.
First my right hon. Friends and I propose to expand the family planning advice services, which from April 1974 will all be the responsibility of the new National Health Service authorities, so that a comprehensive service of advice is readily available free of charge to all who wish to have it. There will be more clinics, more easily accessible, giving free advice on contraceptive methods, and the domiciliary services will be further expanded to enable all who wish and need advice in their homes to receive it. More emphasis will be placed on the offering of advice and where appropriate treatment, to patients in hospital, particularly maternity and abortion patients.
Many people will prefer to consult their general practitioners. At present they receive full advice and services under the National Health Service only where there is a medical need for contraception. I therefore propose to enter into discussions with the medical and pharmaceutical professions to see whether satisfactory arrangements can be agreed with them under which the fees which general practitioners may at present charge National Health Service patients who have no health reasons for avoiding pregnancy, for the work of prescribing the pill or the 235 fitting of an appliance, can be replaced by appropriate remuneration from official sources.
Secondly it is clear that we still need to do more to inform the public about the services available and to encourage them to use them. I intend to make extra funds available to the Health Education Council for this purpose and am providing money for special training courses for professional workers.
Finally, my right hon. Friends and I have concluded that there should be free contraceptive supplies for those who have a special social need and who would otherwise be unlikely to undertake effective contraception as well as for those with a financial need. We propose a new category for automatic exemption from charges for family planning supplies, that is women who have had a baby or an abortion within the previous 12 months. Apart from these, people with a medical need will pay no more than the standard prescription charge. Others will pay the full cost of their supplies.
I believe that these new arrangements will be generally welcomed. They will be implemented as soon as possible. Their cost will depend on the use which the public makes of the new services. We expect that in response to this demand the total cost for England, Wales and Scotland will build up to about £12 million per year over the next four years compared with current annual expenditure of about £4 million. This represents total additional expenditure of £20 million over the four-year period.

§ Dr. Summerskill
We on this side of the House can welcome the right hon. Gentleman's statement on the ground that the family planning service will at last become a Government responsibility within the reorganised health service, while appreciating the work done in the past by the Family Planning Association, local authorities and general practitioners. Will the right hon. Gentleman bear in mind, however, that in other respects the proposals about which we have just heard are totally inadequate to reduce substantially the number of unplanned pregnancies, as well, as being vague and full of anomalies. Free advice without free supplies is totally illogical and is a serious deterrent to those in the lower income groups to seek advice.
236 Does not the right hon. Gentleman agree that it is shutting the stable door after the horse has bolted to provide free family planning to a woman who has already had an abortion and to a woman who has already had an illegitimate child—that is, those who fall into the rather vague category of "social need"? Will the right hon. Gentleman explain the logic of these proposals? Will he bear in mind that the only fair and effective family planning service is one that is available free of charge and is easily accessible to every man and woman, married or unmarried, healthy or sick, with no children or with six children? Only in this way can every child born be a wanted child. Surely this ought to be possible within a health service which spends more than £2,000 million a year. Finally, will the right hon. Gentleman say what charges he will be making? Will there be yet another means test to decide who qualifies for free appliances on grounds of financial need?

§ Sir K. Joseph
The hon. Member for Halifax (Dr. Summerskill) says that she is pleased that the Government are taking responsibility. I must emphasise that in the view of most people it is the parents' responsibility to decide whether to use family planning methods. The Government accept a responsibility to make advice available and to a limited but substantial extent to make supplies available to those who either are not socially competent otherwise to provide for themselves or have not the resources to do so.
The hon. Lady says that this statement is totally inadequate. However it provides for a trebling of expenditure when this Government have already trebled expenditure on family planning services. Over the next four years, therefore, we are dealing with a ninefold increase in public expenditure for family planning. In a matter as difficult as this, where an incautious step can do more harm than good, however good the intentions, it is right to have some caution.
The hon. Lady asks about means tests. We shall try to attach the exemption to exemption arrangements already made for other services and details will be available later.
Finally the hon. Lady and her party should say where, among all the other vague undertakings that they are giving 237 to abolish charges here and to increase health services there, this fits into their priorities. Although they are very ready to ask for more, they never accept the need to put their causes into some series of importance.

§ Mrs. Knight
Will my right hon. Friend accept the congratulations of those of us who have for so long been pressing for a responsible medically-based service along these lines?
Will he tell us a little more about the domiciliary aspect of this matter? Those of us who worked for so long on the Select Committee on Race Relations were well aware that in poorer areas, particularly among the immigrant population who did not go about very much, there was a real need for a domiciliary service to help in family planning. Will the new plans include this point?

§ Sir K. Joseph
I am grateful to my hon. Friend. The local authorities, following the Government's request in 1971, have already brought about what will probably be seen by the end of this year to have been a trebling of expenditure on their services largely by way of increasing the very domiciliary services to which my hon. Friend refers. When the responsibility passes to the new National Health Service authorities in April 1974, I can guarantee that domiciliary services will be given their proper importance, which is very great indeed.

§ Mr. David Steel
While this statement will be widely welcomed as a step in the right direction, may I ask whether the right hon. Gentleman is aware that it falls far short of a very comprehensive family planning service under the National Health Service? How does he intend to define special social and financial need? What is the logic of ending the free provision of supplies 12 months after the end of a previous pregnancy?

§ Sir K. Joseph
We should get an impression of the proportion involved in today's statement. I am advised that, concerning costs, what is involved will go more than half way towards providing—which I do not accept is necessary—a totally free service for all who wish it.
Secondly, regarding social need, professional workers, such as health visitors 238 and social workers, will be entitled to identify individuals who in their view need free provision of supplies on social need, which will often correspond to, but will not always overlap and may be different from, financial need.
On the third question, we thought it wise to provide free supplies during the 12 months after childbirth or abortion in order that any woman who has not been using contraceptive methods may have the advantage of free supplies to remove any barrier she might have had to adopting contraceptive methods if she and her husband so wish.

§ Dr. Stuttaford
First, does my right hon. Friend intend that general practitioners should be paid by the State for writing out private prescriptions for contraceptives? Secondly, will it be up to the general practitioner to decide whether social grounds exist among his patients? It must be the goal of all eventually to see that all prescriptions for this sort of thing should be on the ordinary EC 10 form.

§ Sir K. Joseph
It is the Government's intention that, subject to negotiations with the medical profession, the charge which medical practitioners now make for prescribing for non-medical purposes shall be replaced by a fee paid by the taxpayer. It will also be necessary to adhere to the social-medical distinction, and this will be one of the subjects which we shall be discussing with the medical profession.

§ Mrs. Renée Short
Is the right hon. Gentleman aware that, while we accept this is a small step, it goes nowhere near to meeting the demands that were put forward by hon. Members on both sides of the House in the Select Committee's Report? It is therefore a very disappointing statement. What steps is he taking to make sure that medical students now have family planning and birth control techniques included in their curricula? How much does he intend to spend on advertising? Will he assure the House that he will not succumb to pressure from bigoted or ignorant people who try to put pressure on him to withdraw advertising in public places for this purpose?

§ Sir K. Joseph
Medical education is not a matter for me, but I am sure that my right hon. Friend the Secretary of 239 State for Education and Science will take into account the hon. Lady's point about that matter. I shall be discussing with the Health Education Council the amount that it will need to mount an effective series of public education activities.

Several Hon. Members
rose—

§ Mr. Speaker
I am afraid the House must find another opportunity for pursuing this matter further. We have a lot to do and an important debate.

§ Mr. Simon Mahon
On a point of order, Mr. Speaker. Before we proceeded to the introduction of new Members we were discussing the statement concerning the introduction of the family planning service. It appeared to me, as one who is not wholly in favour of the outline of the policy, that very little chance was given to hon. Members who opposed the new proposals. As one who comes from a large family, may I be allowed now to ask two questions?

§ Mr. Speaker
Order. It is a matter for my discretion when I stop questions on a statement. However, I indicated that I thought it was a matter to be debated on another occasion. It seemed to me that we were getting into a debate today. Therefore, because I have to protect the time of the House and as there is an important debate ahead of us, I exercised my discretion and stopped the proceedings. I am afraid that the hon. Member cannot ask any further questions.

§ Mr. Mahon
Further to that point of order, Mr. Speaker. You said that a further opportunity would be given to those who disagreed. Have you any idea when that will come about?

§ Mr. Speaker
That is a matter not for me but for the Leader of the House.

§ Mr. Robert Hughes
I appreciate the difficulty that faces the House when there is an omnibus statement affecting England, Scotland and Wales, but may I ask whether you are able to give protection to a number of Scottish back benchers who wish to ask questions on this matter?

§ Mr. Speaker
The Chair always gets in a difficulty when it tries to shorten proceedings. This is an Opposition 240 Supply Day, and I am trying to protect the Opposition's time. There is an important debate ahead of us and I am trying to get on to it as quickly as possible. There is also a Ten-Minute Rule Bill and one or two other matters to be dealt with before we come to the main debate. I am trying to protect the Opposition's time, and matters of further debate or further discussions must be dealt with by the Leader of the House when business is discussed on a Thursday.

§ Mr. Fell
On a number of previous occasions when you have been in this kind of difficulty, Mr. Speaker, the Leader of the House has been able to intervene and to let us know that shortly there is to be a debate. I wonder whether he could do that today.

§ Mr. Speaker
Thursday is the proper time for that sort of question.